Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1087
ICR Reference No:
201005-0938-012
Status:
Historical Active
Previous ICR Reference No:
201004-0938-012
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Early Retiree Reinsurance Program
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Emergency
Approval Requested By:
04/30/2010
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/02/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/26/2010
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2010
11/30/2010
11/30/2010
Responses
45,800
0
45,800
Time Burden (Hours)
854,675
0
854,675
Cost Burden (Dollars)
0
0
0
Abstract:
Under the Patient Protection and Affordable Care Act (P.L. 111-148) and implementing regulations at 45 CFR Part 149, employment-based plans that offer health coverage to early retirees and their spouses, surviving spouses, and dependents are eligible to receive tax-free reimbursement for a portion of the costs of health benefits provided to such individuals. To qualify, a plan sponsor must submit a complete application to HHS, and must submit reimbursement requests that consist of a list of individuals for whom reimbursement is sought, and documentation of the costs of health benefits provided.
Emergency Justfication:
See the attached emergency justification.
Authorizing Statute(s):
PL:
Pub.L. 111 - 148 1102
Name of Law: Patient Protection and Affordable Care Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
18
IC Title
Form No.
Form Name
Change of Ownership (Private)
Change of Ownership (Public)
Data Inaccuracies (Private)
Data Inaccuracies (Public)
Early Retiree Reinsurance Program - Private Application
CMS-10321
CMS-10321.ERRP Application
Early Retiree Reinsurance Program - Public Application
CMS-10321
CMS-10321.ERRP Application
Fraud and Abuse Procedures (Private) - Out Years
Fraud and Abuse Procedures (Private) - Year 1
Fraud and Abuse Procedures (Public) - Out Years
Fraud and Abuse Procedures (Public) - Year 1
Mainenance of Records (Private)
Maintenance of Records (Public)
Reimbursement Requests (Private)
Reimbursement Requests (Public)
Written Agreements (Private ) - Year 1
Written Agreements (Private) - Out Years
Written Agreements (Public) - Out Years
Written Agreements (Public) - Year 1
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
45,800
45,800
0
0
0
0
Annual Time Burden (Hours)
854,675
854,675
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$20,000,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Yes
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
William Parham 4107864669
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/26/2010
An official website of the United States government
The .gov means it's official.
The site is secure.
